I must vent about my first clinical

[Doczilla]

Some of it depends on whether or not your preceptor has any prehospital experience (I mean REAL experience, not some nurse who challenged the medic exam just for S&G). Many nurses see prehospital providers as ill-educated and subordinate, yet not really "one of their own". I found in my clinicals that there were many former medics/now RNs who took very good care of me, making sure to pimp me on patient scenarios and examination technique. I found also that nurses at the community hospitals tended to be more willing to take the time to teach and give me opportunities to practice skills, perhaps because they see students less as interfering with them doing their job. If more people felt that teaching was a testament to their knowledge and experience rather than just a chore, more might do it. I've met docs who were the same way toward medical students.

I think you've got the right attitude and right approach. Some of your preceptors, as they get to know you, will allow you more participation and teach more. Other tools just won't, and you know to stay away from them. In the meantime, always keep the good attitude, keep showing your desire to participate, and never shy away from scut work. Be proactive, and be IN THE WAY (but don't just stand there). Don't watch from the corner, get into the middle of things and start doing.

'zilla

[xselerate]

Better luck with your ambulance rotation, and keep at it.

[Juice]

When I worked my clinicals, I started out in triage seeing all of the patients that came to the ER and assessing their problem, vitals, etc. The 2nd night I was on the floor and had a couple ER nurses like you had. I started out by helping them. By this I mean cleaning the cots and counters after the Pts were discharged. They seemed to appreciate that and actually called for me when there were patients with conditions that would of great benefit to me. By the 4th night, I was recording data on charts, following the ER docs around and actually felt accepted.

Sometimes it is best to start at the bottom (changing sheets, cleaning counters) to get to the top.

My .02

[Just Plain Ruff]

I've been on both sides of the clinicals issue. I've precepted in the ED And also been a student.

It definately helps to show that you are not only interested in the good stuff but also interested in cleaning up after granny who has C-diff or the little kid who just puked up 2 cups of activated charcoal.

I can say that I always looked more highly on the student willing to help me clean up my rooms instead of the student who miraculously vanished when I needed some extra help. You can guess who got to see the good stuff.

We used to practice intubation on codes that were brought in and called. you can bet that the student who was involved in all aspects of patient care were the ones who were brought in for special extras like that.

I actually had a student tell me "I don't change bed linens or clean up puke" I said in reply "are you serious" he replied "Yes, I don't do that crap" I then asked to see his evaluation - I marked all 1's and said "well then, you can't be a student here, you can go home"

He was really really pissed.

He was my 32nd student that month.

[Ridryder 911]

This is interesting or ironic.. I just met with a Paramedic instructor and he was informing me of some of the difficulties that EMS students are having difficulties in clinical sites. He asked me if I would design or meet with his students on how to successfully succeed in hospital clinical areas.

So here are some suggestions off the top of my head:

1) Come prepared..okay sounds like a no brainer but seriously... Do you really know what your clinical objectives are ?

2) Be there on time ... better yet, be there early. Yes, consider this like work or an employer... you really are representing 3 things. Yourself, the school, and yes the clinical site you are at.

3) Show up clean, groomed, rested, and yes in full clinical uniform that is clean, ironed, and shoes shined etc.. I had to send 6 students home last semester. 1 had body odor so foul, 3 other looked liked they slept in their uniform, 1 without name badges or credential I.D.'s, the other worked all night, so all he could do was try to stay awake and sleep in a chair.. you are wasting my time and yours.. go home.

4) Introduce your self... ever seen a shy medic ?............ Ask to speak to whom is in charge. They will direct you to the proper person. Ask, if they will assign you or will you float among the staff. Introduce yourself to clinical staff when possible. When introducing yourself, state your name and the level you are there for ..... sorry, I see too many students to know what level you are.

5) Ask them if they will keep you informed if they have an interesting case. I suggest to introduce yourself to the clerk or data enter... since they will be placing orders in, they will know where the interesting cases are as well.

6) As others have described... seem interested. It is your duty to learn.. this means listening, observing, touching and assisting. Ask to assist with some routine duties. No you are not there to be an cleaner or do all the dirty tasks, but do assist when possible. I have seen two types of students .... those that would not help at all and those that will not do nothing but routine tasks, and are not interested in interesting cases.

7) Don't charge in and take over... ask if they would like you to __________?. After, working with a preceptor a while, they will let you know when you don't have to ask.

8) Ask about the medical case in private.. if you don't understand, ask appropriate questions. Ask if they have reading material or information if more is needed.

9) Be nice to patients.. and family as well as other staff members. Housekeeping, x-ray, etc...

10) You can talk about yourself... please a little will go a long way. When talking about your class, please don't go overboard about how bad or good it is ... they probably already know. Again, don't be a wall flower but don't be an ear full.

11) When it is about time to leave... have you papers ready to be signed. Try to have an exit interview prior to time to leave, to talk to your preceptor. Ask them your weak points as well as positive.

12) Allow the preceptor some time to sign their comments in private..

13) If there is an interesting case, that comes at the same time you are to leave... I highly suggest asking to stay to help or observe. When a student leaves & it is a good case... it demonstrates to me that they really don't give a damn. Again, ask nicely, they may have plenty of help.. etc.. but asking sure presents a good image.

14) Lastly, thank them... and smile. The old thank-you card is nice... after you have completed your rotations. Lasting impressions. You never know whom might be on that hiring committee... :wink:

Have fun, keep your eyes & ears open.. watch and observe, talk to patients. Learn as much as you can... there is plenty of that to do daily.

Be safe,

R/R 911

Okay, that is some basics..

[Dustdevil]

12) Allow the preceptor some time to sign their comments in private..

Ideally, a program would not put preceptors in the position of having to hand their evaluation back to the student personally. They should be kept and collected by the instructor or coordinator. To do otherwise is just asking for dishonest evaluations.

[Dsmittty911]

Dust I see what you mean about not handing eval's back to student. I guess I never thought about that because I'm not the kind to forge eval's to make me look better. I also knew a lot of the staff already so I was able to sit down and do somewhat of an interview with them to get specific on what they saw, attributes,areas I needed to work on, general comments (good and bad). I made myself available for anything in the ED so they would know I was serious about helping out and learning. I got called in to observe several things. On one case the doc told me to get sterile and told the ER Tech who was setting up suture kits and such that he could go. He wanted me to assist.

About the only reason I looked on the sheets they filled out was to see if perhaps there was a comment that they forgot to mention or something they didn't tell me about. I actually like having the sheets in my notebook because I would periodically look over them to find shortcomings and things I needed to work on. About the only negative (or in this case neutral) comment was made by a charge nurse who stated that because of the types of pt's in ED that night I didn't get to work on skills as much as she would have liked. But I helped with a lot of stuff that night. The nurse I was assigned to kept getting called for traumas where I could do a few things but not a lot. Monitor vitals etc. Anyway I see your point and it's said that you'd have to think about people writing their own evals (false) ......

[Ridryder 911]

As a program coordinator I always had 3 forms for the evaluation. One for the preceptor to fill out for the student to fill out daily, what they seen, whom they worked with etc. with some brief lines that the preceptor could fill out to give the student some ideas, suggestions or even kudos. The grade form was given to the preceptor and was was placed in a lock box for me or other instructors to pick up. The student was allowed as well to evaluate the preceptor and the clinical site.

This definitely helped identifying helpful preceptors and better clinical sites. I believe honest student eval's was given do to privacy of the eval.'s....

I know it more time consuming, but worth it...

Be safe,

R/R 911

[Dustdevil]

Dust I see what you mean about not handing eval's back to student. I guess I never thought about that because I'm not the kind to forge eval's to make me look better.

LOL! I didn't think of that either. I like it though!

Nah, I meant the evaluator was much more likely to be forthcoming with an honest appraisal if he didn't have to hand it back to the student to read. Kinda like the secret ballot theory.